Search results for: iliac vein compression syndrome
Commenced in January 2007
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Edition: International
Paper Count: 1876

Search results for: iliac vein compression syndrome

1306 The Evaluation of Complete Blood Cell Count-Based Inflammatory Markers in Pediatric Obesity and Metabolic Syndrome

Authors: Mustafa M. Donma, Orkide Donma

Abstract:

Obesity is defined as a severe chronic disease characterized by a low-grade inflammatory state. Therefore, inflammatory markers gained utmost importance during the evaluation of obesity and metabolic syndrome (MetS), a disease characterized by central obesity, elevated blood pressure, increased fasting blood glucose and elevated triglycerides or reduced high density lipoprotein cholesterol (HDL-C) values. Some inflammatory markers based upon complete blood cell count (CBC) are available. In this study, it was questioned which inflammatory marker was the best to evaluate the differences between various obesity groups. 514 pediatric individuals were recruited. 132 children with MetS, 155 morbid obese (MO), 90 obese (OB), 38 overweight (OW) and 99 children with normal BMI (N-BMI) were included into the scope of this study. Obesity groups were constituted using age- and sex-dependent body mass index (BMI) percentiles tabulated by World Health Organization. MetS components were determined to be able to specify children with MetS. CBC were determined using automated hematology analyzer. HDL-C analysis was performed. Using CBC parameters and HDL-C values, ratio markers of inflammation, which cover neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte-to-HDL-C ratio (MHR) were calculated. Statistical analyses were performed. The statistical significance degree was considered as p < 0.05. There was no statistically significant difference among the groups in terms of platelet count, neutrophil count, lymphocyte count, monocyte count, and NLR. PLR differed significantly between OW and N-BMI as well as MetS. Monocyte-to HDL-C value exhibited statistical significance between MetS and N-BMI, OB, and MO groups. HDL-C value differed between MetS and N-BMI, OW, OB, MO groups. MHR was the ratio, which exhibits the best performance among the other CBC-based inflammatory markers. On the other hand, when MHR was compared to HDL-C only, it was suggested that HDL-C has given much more valuable information. Therefore, this parameter still keeps its value from the diagnostic point of view. Our results suggest that MHR can be an inflammatory marker during the evaluation of pediatric MetS, but the predictive value of this parameter was not superior to HDL-C during the evaluation of obesity.

Keywords: children, complete blood cell count, high density lipoprotein cholesterol, metabolic syndrome, obesity

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1305 Effect of Lime and Leaf Ash on Engineering Properties of Red Mud

Authors: Pawandeep Kaur, Prashant Garg

Abstract:

Red mud is a byproduct of aluminum extraction from Bauxite industry. It is dumped in a pond which not only uses thousands of acres of land but having very high pH, it pollutes the ground water and the soil also. Leaves are yet another big waste especially during autumn when they contribute immensely to the blockage of drains and can easily catch fire, among other risks hence also needs to be utilized effectively. The use of leaf ash and red mud in highway construction as a filling material may be an efficient way to dispose of leaf ash and red mud. In this study, leaf ash and lime were used as admixtures to improve the geotechnical engineering properties of red mud. The red mud was taken from National Aluminum Company Limited, Odisha, and leaf ash was locally collected. The aim of present study is to investigate the effect of lime and leaf ash on compaction characteristics and strength characteristics of red mud. California Bearing Ratio and Unconfined Compression Strength tests were performed on red mud by varying different percentages of lime and leaf ash. Leaf ash was added in proportion 2%,4%,6%,8% and 10% whereas lime was added in proportions of 5% to 15%. Optimized value of lime was decided with respect to maximum CBR (California Bearing Ratio) of red mud mixed with different proportions of lime. An increase of 300% in California Bearing ratio of red mud and an increase of 125% in Unconfined Compression Strength values were observed. It may, therefore, be concluded that red mud may be effectively utilized in the highway industry as a filler material.

Keywords: stabilization, lime, red mud, leaf ash

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1304 Characterization of Structural Elements Concrete Metal Fibre

Authors: Benaouda Hemza

Abstract:

This work on the characterization of structural elements in metal fiber concrete is devoted to the study of recyclability, as reinforcement for concrete, of chips resulting from the machining of steel parts. We are interested in this study to the rheological behavior of fresh chips reinforced concrete and its mechanical behavior at a young age. The evaluation of the workability with the LCL workabilimeter shows that optimal sand gravel ratios (S/G) are S/G=0.8, and S/G=1. The study of the content chips (W%) influence on the workability of the concrete shows that the flow time and the S/G optimum increase with W%. For S/G=1.4, the flow time is practically insensitive to the variation of W%, the concrete behavior is similar to that of self-compacting concrete. Mechanical characterization tests (direct tension, compression, bending, and splitting) show that the mechanical properties of chips concrete are comparable to those of the two selected reference concretes (concrete reinforced with conventional fibers: EUROSTEEL fibers corrugated and DRAMIX fibers). Chips provide a significant increase in strength and some ductility in the post-failure behavior of the concrete. Recycling chips as reinforcement for concrete can be favorably considered.

Keywords: fiber concrete, chips, workability, direct tensile test, compression test, bending test, splitting test

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1303 Improving the Crashworthiness Characteristics of Long Steel Circular Tubes Subjected to Axial Compression by Inserting a Helical Spring

Authors: Mehdi Tajdari, Farzad Mokhtarnejad, Fatemeh Moradi, Mehdi Najafizadeh

Abstract:

Nowadays, energy absorbing devices have been widely used in all vehicles and moving parts such as railway couches, aircraft, ships and lifts. The aim is to protect these structures from serious damages while subjected to impact loads, or to minimize human injuries while collision is occurred in transportation systems. These energy-absorbing devices can dissipate kinetic energy in a wide variety of ways like friction, facture, plastic bending, crushing, cyclic plastic deformation and metal cutting. On the other hand, various structures may be used as collapsible energy absorbers. Metallic cylindrical tubes have attracted much more attention due to their high stiffness and strength combined with the low weight and ease of manufacturing process. As a matter of fact, favorable crash worthiness characteristics for energy dissipation purposes can be achieved from axial collapse of tubes while they crush progressively in symmetric modes. However, experimental and theoretical results have shown that depending on various parameters such as tube geometry, material properties of tube, boundary and loading conditions, circular tubes buckle in different modes of deformation, namely, diamond and Euler collapsing modes. It is shown that when the tube length is greater than the critical length, the tube deforms in overall Euler buckling mode, which is an inefficient mode of energy absorption and needs to be avoided in crash worthiness applications. This study develops a new method with the aim of improving energy absorption characteristics of long steel circular tubes. Inserting a helical spring into the tubes is proved experimentally to be an efficient solution. In fact when a long tube is subjected to axial compression load, the spring prevents of undesirable Euler or diamond collapsing modes. This is because the spring reinforces the internal wall of tubes and it causes symmetric deformation in tubes. In this research three specimens were prepared and three tests were performed. The dimensions of tubes were selected so that in axial compression load buckling is occurred. In the second and third tests a spring was inserted into tubes and they were subjected to axial compression load in quasi-static and impact loading, respectively. The results showed that in the second and third tests buckling were not happened and the tubes deformed in symmetric modes which are desirable in energy absorption.

Keywords: energy absorption, circular tubes, collapsing deformation, crashworthiness

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1302 Characterization of Structural Elements in Metal Fiber Concrete

Authors: Ammari Abdelhammid

Abstract:

This work on the characterization of structural elements in metal fiber concrete is devoted to the study of recyclability, as reinforcement for concrete, of chips resulting from the machining of steel parts. We're interested in this study to the Rheological behavior of fresh chips reinforced concrete and its mechanical behavior at a young age. The evaluation of the workability with the LCL workabilimeter shows that optimal sand gravel ratios ( S/G) are S/G = 0.8 and S/G = 1. The study of the content chips (W%) influence on the workability of the concrete shows that the flow time and the S/G optimum increase with W%. For S/G = 1.4, the flow time is practically insensitive to the variation of W%, the concrete behavior is similar to that of self-compacting concrete. Mechanical characterization tests (direct tension, compression, bending, and splitting) show that the mechanical properties of chips concrete are comparable to those of the two selected reference concretes (concrete reinforced with conventional fibers: Eurosteel fibers corrugated and Dramix fibers). Chips provide a significant increase in strength and some ductility in the post-failure behavior of the concrete. Recycling chips as reinforcement for concrete can be favorably considered.

Keywords: fiber concrete, chips, workability, direct tensile test, compression test, bending test, splitting test

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1301 Histological and Morphometric Studies of the Liver of Goats Aborted

Authors: Toumi Farah, Charallah Salima

Abstract:

In the Algerian Sahara, goat farming is predominant, and it’s associated with other types of breeding, particularly camel and sheep; it also constitutes a significant proportion of breeding exclusively goat. This Saharan goat is a small ruminant with a black dress with white’s spots, hanging ears, and a coat more or less long. It is known for its hardiness and resistance to adverse conditions of arid zones and its perfect ecophysiological adaptation to harsh environmental conditions. However, pregnancy alterations, particularly abortion, degrade its productivity and cause economic losses, having both direct and indirect effects on animal production, like the costs of veterinary interventions and the reconstitution of livestock. The purpose of this work is to study the histological aspect of the liver of goats’ aborted living under nomadic herds in the region of Béni-Abbès (30° 7' N, 2° 10 'O). The organs were collected in physiological serum, rinsed, and then fixed with formaldehyde (37°, diluted at 10%). After that, these samples were processed for a topographic study. The morphometric study of the liver was performed by using an image analysis and processing software "Image J"; the various measurements obtained are intended to specify the supposed stage of development according to the body weight. The histological structure of the liver shows that the hepatic parenchyma consists of vascular conjunctive spaces surrounded by Glisson’s capsule. The sinusoids and hepatic portal vein are full of red blood cells, representing sinusoidal congestion and a thrombosed vein. At high magnification, the blood vessels show the presence of vascular thrombosis and haemorrhage in some areas of the hepatic parenchyma. Morphometric analysis shows that the number of liver parenchymal cells and the diameter of liver vessels vary according to the stage of development. The results obtained will provide details of the anatomical and cellular elements that can be used in the diagnosis of early or late abortion and late embryonic death. It would be interesting to find, by immunohistochemistry, some inflammatory markers useful for monitoring the progress of pregnancy and bioindicators of fetomaternal distress.

Keywords: aborting goat, arid zone, liver, histopathology

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1300 Limit State Evaluation of Bridge According to Peak Ground Acceleration

Authors: Minho Kwon, Jeonghee Lim, Yeongseok Jeong, Jongyoon Moon, Donghoon Shin, Kiyoung Kim

Abstract:

In the past, the criteria and procedures for the design of concrete structures were mainly based on the stresses allowed for structural components. However, although the frequency of earthquakes has increased and the risk has increased recently, it has been difficult to determine the safety factor for earthquakes in the safety assessment of structures based on allowable stresses. Recently, limit state design method has been introduced for reinforced concrete structures, and limit state-based approach has been recognized as a more effective technique for seismic design. Therefore, in this study, the limit state of the bridge, which is a structure requiring higher stability against earthquakes, was evaluated. The finite element program LS-DYNA and twenty ground motion were used for time history analysis. The fracture caused by tensile and compression of the pier were set to the limit state. In the concrete tensile fracture, the limit state arrival rate was 100% at peak ground acceleration 0.4g. In the concrete compression fracture, the limit state arrival rate was 100% at peak ground acceleration 0.2g.

Keywords: allowable stress, limit state, safety factor, peak ground acceleration

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1299 Change in Value System: The Way Forward for Africa

Authors: Awe Ayodeji Samson, Adeuja Yetunde Omowunmi

Abstract:

Corruption is a ‘monster’ that can consume a whole nation, continent and even the world if it is not destroyed while it is still immature; It grows in the mind of the people, takes over their thinking and guides their decision-making process. Corruption snowballs into socio-economic catastrophe that might be difficult to deal with. Corruption which is a disease of the mind can be alleviated in Africa and the world at large by transforming a Corruption-Prone Mind to a Corruption-Immune Mind and to achieve this, we have to change our value system because the use of anti-graft agencies alone is not enough. Therefore, we have to fight corruption from the inside and the outside. Value System is the principle of right and wrong that are accepted by an individual or a social group; the reviewing and reordering of our value system is the solution to the problem of corruption as proposed by this research because the African society has become a ‘Money and Power Driven Society’ where the ‘I am worth concept’ which is a problematic concept has created an ‘Aggressive Society’ with grasping and money-grabbing individuals. We place more priority on money and the display of opulence. Hence, this has led to a ‘Triangular Society’ where minority is lavishing in plenty and majority is gasping for little. The get rich quick syndrome, the ethnicity syndrome, weakened educational system are signs of the prevalence of corruption in Africa This research has analyzed role and impact of the change in our value system in the fight against corruption in Africa and has therefore proposed the change in our value system as the way forward in the fight against corruption in Africa.

Keywords: corruption-prone mind, corruption-immune mind, triangular society, aggressive society, money and power-driven society

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1298 Effectiveness of Mobile Health Augmented Cardiac Rehabilitation (MCard) on Health-Related Quality of Life among Post-Acute Coronary Syndrome Patients: A Randomized Controlled Trial

Authors: Aliya Hisam, Zia Ul Haq, Sohail Aziz, Patrick Doherty, Jill Pell

Abstract:

Objective: To determine the effectiveness of Mobile health augmented Cardiac rehabilitation (MCard) on health-related quality of life (HRQoL) among post-acute coronary syndrome(post-ACS) patients. Methodology: In a randomized controlled trial, post-ACS patients were randomly allocated (1:1) to an intervention group (received MCard; counseling, empowering with self-monitoring devices, short text messages, in addition to standard post-ACS care) or control group (standard post-ACS care). HRQoL was assessed by generic Short Form-12 and MacNew quality of life myocardial infarction (QLMI) tools. Participants were followed for 24 weeks with data collection and analysis at three-time points (baseline, 12 weeks and 24 weeks). Result: At baseline, 160 patients (80 in each group; mean age 52.66+8.46 years; 126 males, 78.75%) were recruited, of which 121(75.62%) continued and were analyzed at 12-weeks and 119(74.37%) at 24-weeks. The mean SF-12 physical component score significantly improved in the MCard group at 12 weeks follow-up (48.93 vs. control 43.87, p<.001) and 24 weeks (53.52 vs. 46.82 p<.001). The mean SF-12 mental component scores also improved significantly in the MCard group at 12 weeks follow-up (44.84 vs. control 41.40, p<.001) and 24 weeks follow-up (48.95 vs 40.12, p<.001). At 12-and 24-week follow-up, all domains of MacNew QLMI (social, emotional, physical and global) were also statistically significant (p<.001) improved in the MCard group, unlike the control group. Conclusion: MCard is feasible and effective at improving all domains of HRQoL. There was an improvement in physical, mental, social, emotional and global domains among the MCard group in comparison to the control group. The addition of MCard programs to post-ACS standard care may improve patient outcomes and reduce the burden on the health care setting.

Keywords: acute coronary syndrome, mobile health augmented cardiac rehabilitation (MCard), cardiovascular diseases, cardiac rehabilitation, health-related quality of life, short form 12, MacNew QLMI

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1297 Efficient Storage and Intelligent Retrieval of Multimedia Streams Using H. 265

Authors: S. Sarumathi, C. Deepadharani, Garimella Archana, S. Dakshayani, D. Logeshwaran, D. Jayakumar, Vijayarangan Natarajan

Abstract:

The need of the hour for the customers who use a dial-up or a low broadband connection for their internet services is to access HD video data. This can be achieved by developing a new video format using H. 265. This is the latest video codec standard developed by ISO/IEC Moving Picture Experts Group (MPEG) and ITU-T Video Coding Experts Group (VCEG) on April 2013. This new standard for video compression has the potential to deliver higher performance than the earlier standards such as H. 264/AVC. In comparison with H. 264, HEVC offers a clearer, higher quality image at half the original bitrate. At this lower bitrate, it is possible to transmit high definition videos using low bandwidth. It doubles the data compression ratio supporting 8K Ultra HD and resolutions up to 8192×4320. In the proposed model, we design a new video format which supports this H. 265 standard. The major areas of applications in the coming future would lead to enhancements in the performance level of digital television like Tata Sky and Sun Direct, BluRay Discs, Mobile Video, Video Conferencing and Internet and Live Video streaming.

Keywords: access HD video, H. 265 video standard, high performance, high quality image, low bandwidth, new video format, video streaming applications

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1296 Baseline CD4 Positive T Lymphocytes Counts among HIV Sero-Positive Patients Attending Benue State University Teaching Hospital, Makurdi, Nigeria

Authors: S. I. Nwadioha, M. S. Odimayo, G. T. A. Jombo, E. O. P. Nwokedi

Abstract:

Aims and Objectives: To determine the baseline CD4 positive T lymphocytes count of HIV/AIDS treatment naïve adults clients presenting for the first time treatment in Benue State University Teaching Hospital. Subjects and Methods: A total of 700 subjects age between 18 years to 70 years, were recruited for the study, comprising 600 HIV sero-positive patients and 100 healthy controls in Benue State University Teaching Hospital, Makurdi from 2013 to 2014. The CD4 counts of the subjects were evaluated using a Partec flow cytometer. Results: CD4 count of 200-299 cells/μl peaked with 25% (n=150/600)[control; 0%( n= 0/100)]. The study also showed that 44% (266/600) of HIV subjects had acquired immunodeficiency syndrome as defined by low CD4 counts below 200 cells/μl. Seventy-five per cent (n=451/600)of our patients would require to be placed on antiretroviral therapy with CD4 count of less than 350 cells/μl. At CD4 350 baseline criterion, age group 20-29 years had the highest demand 35%(160/451) for ARV followed by age groups 30-39 and 40-49 years with 28%(128/451) and 22%(98/451) respectively. Conclusion: There is a high prevalence of acquired immunodeficiency syndrome as defined by CD4 counts below 200 cells/μl, among the young active productive age group. The strict adopting of the ART WHO 2010 scale- up criteria doubles the number of the HIV clients that would qualify for ART with its attendant health benefits on the long run.

Keywords: CD4 counts, HIV patients, young age group, Nigeria

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1295 A Case Study of Misinterpretation of Results in Forensic DNA Cases Due to Expression of Y- Chromosome in Females

Authors: Garima Chaudhary

Abstract:

The gender of an individual in forensic DNA analysis is normally accessed by using the STR multiplexes with the incorporated gender based marker amelogenin or in other words by presence or absence of Y-Chromosome, but it may not be true in all the cases. We hereby report an interesting case of a phenotypic female carrying a male karyotype (46XY). In the alleged murder case, the deceased female with XY genotype was noticed. The expression of 18 Y-linked genes was studied to measure the extent of expression. Expression at 4 loci was observed that might have caused the misinterpretation in forensic casework. This clinical situation of the deceased in this case was diagnosed as testicular feminization syndrome, which characterize a female phenotype with a male karyotype (46, XY). Most of these cases have SRY (testis determining factor). The genetic explanation of this phenomenon is not very clear. Here, we are discussing the impact of such situations of genetic discrepancy in forensic interpretation of results. In the presented murder case of a phenotypic female, sexual assault was also suspected. For confirmation vaginal swabs and micro slides were also sent to us for DNA examination. After DNA analysis using STR markers, Y-chromosome was detected in the samples which supporting the suspicion of sexual assault before murder. When the reference blood sample of the deceased was analyzed, it was found to be case of testicular feminization syndrome. Interesting inferences were made from the results obtained.

Keywords: DNA profiling, forensic case study, Y chromosome, females

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1294 Associations between Surrogate Insulin Resistance Indices and the Risk of Metabolic Syndrome in Children

Authors: Mustafa M. Donma, Orkide Donma

Abstract:

A well-defined insulin resistance (IR) is one of the requirements for the good understanding and evaluation of metabolic syndrome (MetS). However, underlying causes for the development of IR are not clear. Endothelial dysfunction also participates in the pathogenesis of this disease. IR indices are being determined in various obesity groups and also in diagnosing MetS. Components of MetS have been well established and used in adult studies. However, there are some ambiguities particularly in the field of pediatrics. The aims of this study were to compare the performance of fasting blood glucose (FBG), one of MetS components, with some other IR indices and check whether FBG may be replaced by some other parameter or ratio for a better evaluation of pediatric MetS. Five-hundred and forty-nine children were involved in the study. Five groups were constituted. Groups 109, 40, 100, 166, 110, 24 children were included in normal-body mass index (N-BMI), overweight (OW), obese (OB), morbid obese (MO), MetS with two components (MetS2) and MetS with three components (MetS3) groups, respectively. Age and sex-adjusted BMI percentiles tabulated by World Health Organization were used for the classification of obesity groups. MetS components were determined. Aside from one of the MetS components-FBG, eight measures of IR [homeostatic model assessment of IR (HOMA-IR), homeostatic model assessment of beta cell function (HOMA-%β), alanine transaminase-to-aspartate transaminase ratio (ALT/AST), alanine transaminase (ALT), insulin (INS), insulin-to-FBG ratio (INS/FBG), the product of fasting triglyceride and glucose (TyG) index, McAuley index] were evaluated. Statistical analyses were performed. A p value less than 0.05 was accepted as the statistically significance degree. Mean values for BMI of the groups were 15.7 kg/m2, 21.0 kg/m2, 24.7 kg/m2, 27.1 kg/m2, 28.7 kg/m2, 30.4 kg/m2 for N-BMI, OW, OB, MO, MetS2, MetS3, respectively. Differences between the groups were significant (p < 0.001). The only exception was MetS2-MetS3 couple, in spite of an increase detected in MetS3 group. Waist-to-hip circumference ratios significantly differed only for N-BMI vs, OB, MO, MetS2; OW vs MO; OB vs MO, MetS2 couples. ALT and ALT/AST did not differ significantly among MO-MetS2-MetS3. HOMA-%β differed only between MO and MetS2. INS/FBG, McAuley index and TyG were not significant between MetS2 and MetS3. HOMA-IR and FBG were not significant between MO and MetS2. INS was the only parameter, which showed statistically significant differences between MO-MetS2, MO-MetS3, and MetS2-MetS3. In conclusion, these findings have suggested that FBG presently considered as one of the five MetS components, may be replaced by INS during the evaluation of pediatric morbid obesity and MetS.

Keywords: children, insulin resistance indices, metabolic syndrome, obesity

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1293 Harnessing Nigeria's Forestry Potential for Structural Applications: Structural Reliability of Nigerian Grown Opepe Timber

Authors: J. I. Aguwa, S. Sadiku, M. Abdullahi

Abstract:

This study examined the structural reliability of the Nigerian grown Opepe timber as bridge beam material. The strength of a particular specie of timber depends so much on some factors such as soil and environment in which it is grown. The steps involved are collection of the Opepe timber samples, seasoning/preparation of the test specimens, determination of the strength properties/statistical analysis, development of a computer programme in FORTRAN language and finally structural reliability analysis using FORM 5 software. The result revealed that the Nigerian grown Opepe is a reliable and durable structural bridge beam material for span of 5000mm, depth of 400mm, breadth of 250mm and end bearing length of 150mm. The probabilities of failure in bending parallel to the grain, compression perpendicular to the grain, shear parallel to the grain and deflection are 1.61 x 10-7, 1.43 x 10-8, 1.93 x 10-4 and 1.51 x 10-15 respectively. The paper recommends establishment of Opepe plantation in various Local Government Areas in Nigeria for structural applications such as in bridges, railway sleepers, generation of income to the nation as well as creating employment for the numerous unemployed youths.

Keywords: bending and deflection, bridge beam, compression, Nigerian Opepe, shear, structural reliability

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1292 Dynamic Web-Based 2D Medical Image Visualization and Processing Software

Authors: Abdelhalim. N. Mohammed, Mohammed. Y. Esmail

Abstract:

In the course of recent decades, medical imaging has been dominated by the use of costly film media for review and archival of medical investigation, however due to developments in networks technologies and common acceptance of a standard digital imaging and communication in medicine (DICOM) another approach in light of World Wide Web was produced. Web technologies successfully used in telemedicine applications, the combination of web technologies together with DICOM used to design a web-based and open source DICOM viewer. The Web server allowance to inquiry and recovery of images and the images viewed/manipulated inside a Web browser without need for any preinstalling software. The dynamic site page for medical images visualization and processing created by using JavaScript and HTML5 advancements. The XAMPP ‘apache server’ is used to create a local web server for testing and deployment of the dynamic site. The web-based viewer connected to multiples devices through local area network (LAN) to distribute the images inside healthcare facilities. The system offers a few focal points over ordinary picture archiving and communication systems (PACS): easy to introduce, maintain and independently platforms that allow images to display and manipulated efficiently, the system also user-friendly and easy to integrate with an existing system that have already been making use of web technologies. The wavelet-based image compression technique on which 2-D discrete wavelet transform used to decompose the image then wavelet coefficients are transmitted by entropy encoding after threshold to decrease transmission time, stockpiling cost and capacity. The performance of compression was estimated by using images quality metrics such as mean square error ‘MSE’, peak signal to noise ratio ‘PSNR’ and compression ratio ‘CR’ that achieved (83.86%) when ‘coif3’ wavelet filter is used.

Keywords: DICOM, discrete wavelet transform, PACS, HIS, LAN

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1291 Therapeutic Efficacy and Safety Profile of Tolvaptan Administered in Hyponatremia Patients

Authors: Sree Vennela P., V. Samyuktha Bhardwaj

Abstract:

Hyponatremia is an electrolyte disturbance in which the sodium ion concentration in the serum is lower than normal. Sodium is the dominant extracellular cation (positive ion) and cannot freely cross from the interstitial space through the cell membrane, into the cell. Its homeostasis (stability of concentration) inside the cell is vital to the normal function of any cell. Normal serum sodium levels are between 135 and 145 mEq/L. Hyponatremia is defined as a serum level of less than 135 mEq/L and is considered severe when the serum level is below 125 mEq/L. In the vast majority of cases, Hyponatremia occurs as a result of excess body water diluting the serum sodium (salt level in the blood). Hyponatremia is often a complication of other medical illnesses in which excess water accumulates in the body at a higher rate than can be excreted (for example in congestive heart failure, syndrome of inappropriate antidiuretic hormone, SIADH, or polydipsia). Sometimes it may be a result of over-hydration (drinking too much water).Lack of sodium (salt) is very rarely the cause of Hyponatremia, although it can promote Hyponatremia indirectly. In particular, sodium loss can lead to a state of volume depletion (loss of blood volume in the body), with volume depletion serving as a signal for the release of ADH (anti-diuretic hormone). As a result of ADH-stimulated water retention (too much water in the body), blood sodium becomes diluted and Hyponatremia results.

Keywords: Tolvaptan, hyponatremia, syndrome of insufficient anti diuretic hormone (SIADH), euvolemic hyponatremia

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1290 Mechanical Properties, Vibrational Response and Flow-Field Analysis of Staghorn Coral Skeleton, Acropora cervicornis

Authors: Alejandro Carrasco-Pena, Mahmoud Omer, Nina Orlovskaya

Abstract:

The results of studies of microstructure, mechanical behavior, vibrational response, and flow field analysis of critically endangered staghorn coral (Acropora cervicornis) skeletons are reported. The CaCO₃ aragonite structure of a chemically-cleaned coral skeleton of A. cervicornis was studied by optical microscopy and computer tomography. The mechanical behavior was studied using uniaxial compression and Vickers hardness technique. The average maximum stress measured during skeleton uniaxial compression was 10.7 ± 2.24 MPa and Vickers hardness was 3.56 ± 0.31 GPa. The vibrational response of the aragonite structure was studied by micro-Raman spectroscopy, which showed a substantial dependence of the structure on applied compressive stress. The flow-field around a single coral skeleton forming vortices in the wake of the moving skeleton was measured using Particle Image Velocimetry (PIV). The results are important for further analysis of time-dependent mechanical fatigue behavior and predicting the lifetime of staghorn corals.

Keywords: failure, mechanical properties, microstructure, Raman spectroscopy

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1289 The Impact of Missense Mutation in Phosphatidylinositol Glycan Class A Associated to Paroxysmal Nocturnal Hemoglobinuria and Multiple Congenital Anomalies-Hypotonia-Seizures Syndrome 2: A Computational Study

Authors: Ashish Kumar Agrahari, Amit Kumar

Abstract:

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal blood disorder that manifests with hemolytic anemia, thrombosis, and peripheral blood cytopenias. The disease is caused by the deficiency of two glycosylphosphatidylinositols (GPI)-anchored proteins (CD55 and CD59) in the hemopoietic stem cells. The deficiency of GPI-anchored proteins has been associated with the somatic mutations in phosphatidylinositol glycan class A (PIGA). However, the mutations that do not cause PNH is associated with the multiple congenital anomalies-hypotonia-seizures syndrome 2 (MCAHS2). To best of our knowledge, no computational study has been performed to explore the atomistic level impact of PIGA mutations on the structure and dynamics of the protein. In the current work, we are mainly interested to get insights into the molecular mechanism of PIGA mutations. In the initial step, we screened the most pathogenic mutations from the pool of publicly available mutations. Further, to get a better understanding, pathogenic mutations were mapped to the modeled structure and subjected to 50ns molecular dynamics simulation. Our computational study suggests that four mutations are highly vulnerable to altering the structural conformation and stability of the PIGA protein, which illustrates its association with PNH and MCAHS2 phenotype.

Keywords: homology modeling, molecular dynamics simulation, missense mutations PNH, MCAHS2, PIGA

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1288 Spinal Hydatidosis: Therapeutic Management of 5 Cases

Authors: Ghoul Rachid Brahim, Trad Khodja Rafik

Abstract:

Vertebral localization of the hydatid cyst is a severe form of bone hydatidosis, is a parasitic infection caused by the larval forms of the tapeworms Echinococcus granulosus, The disease is slowly remaining silent (a long incubation period) which may explain why this pathology is often discovered at the stage of neurological complications. The objective of this study is to recall the clinical and radiological aspects of this condition and the importance of early diagnosis and appropriate management. We report a study of 5 patients with vertebral hydatidosis, four men and one woman, four (04) patients operated in the emergency setting for spinal cord compression (decompression by wide laminectomy with evacuation of intra and extra canal vesicles).Albendazole-based medical treatment is instituted in all patients. Results: The evolution was favorable for three patients, the other two patients reoperated for a local recurrence. Conclusion: Vertebral hydatidosis is a rare condition with a poor prognosis due to the risk of neurological damage, the infiltrating nature of bone lesions, the frequency of relapses and therapeutic difficulties. The only curative method remains surgery, which must aim for complete and large excision of the lesions as if it were a “malignant tumour”.

Keywords: hydatidosis, Echinococcosis granulosus, hydatid cyst, spinal cord compression, laminectomy

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1287 Sandwich Structure Composites: Effect of Kenaf on Mechanical Properties

Authors: Maizatulnisa Othman, Mohamad Bukhari, Zahurin Halim, Souad A. Muhammad, Khalisani Khalid

Abstract:

Sandwich structure composites produced by epoxy core and aluminium skin were developed as potential building materials. Interface bonding between core and skin was controlled by varying kenaf content. Five different weight percentage of kenaf loading ranging from 10 wt% to 50 wt% were employed in the core manufacturing in order to study the mechanical properties of the sandwich composite. Properties of skin aluminium with epoxy were found to be affected by drying time of the adhesive. Mechanical behavior of manufactured sandwich composites in relation with properties of constituent materials was studied. It was found that 30 wt% of kenaf loading contributed to increase the flexural strength and flexural modulus up to 102 MPa and 32 Gpa, respectively. Analysis were done on the flatwise and edgewise compression test. For flatwise test, it was found that 30 wt% of fiber loading could withstand maximum force until 250 kN, with compressive strength results at 96.94 MPa. However, at edgewise compression test, the sandwich composite with same fiber loading only can withstand 31 kN of the maximum load with 62 MPa of compressive strength results.

Keywords: sandwich structure composite, epoxy, aluminium, kenaf fiber

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1286 Effect of Labisia pumila var. alata with a Structured Exercise Program in Women with Polycystic Ovarian Syndrome

Authors: D. Maryama AG. Daud, Zuliana Bacho, Stephanie Chok, DG. Mashitah PG. Baharuddin, Mohd Hatta Tarmizi, Nathira Abdul Majeed, Helen Lasimbang

Abstract:

Lifestyle, physical activity, food intake, genetics and medication are contributing factors for people getting obese. Which in some of the obese people were a low or non-responder to exercise. And obesity is very common clinical feature in women affected by Polycystic Ovarian Syndrome (PCOS). Labisia pumila var. alata (LP) is a local herb which had been widely used by Malay women in treating menstrual irregularities, painful menstruation and postpartum well-being. Therefore, this study was carried out to investigate the effect of LP with a structured exercise program on anthropometric, body composition and physical fitness performance of PCOS patients. By using a single blind and parallel study design, where by subjects were assigned into a 16-wk structured exercise program (3 times a week) interventions; (LP and exercise; LPE, and exercise only; E). All subjects in the LPE group were prescribed 200mg LP; once a day, for 16 weeks. The training heart rate (HR) was monitored based on a percentage of the maximum HR (HRmax) achieved during submaximal exercise test that was conducted at wk-0 and wk-8. The progression of aerobic exercise intensity from 25–30 min at 60 – 65% HRmax during the first week to 45 min at 75–80% HRmax by the end of this study. Anthropometric (body weight, Wt; waist circumference, WC; and hip circumference, HC), body composition (fat mass, FM; percentage body fat, %BF; Fat Free Mass, FFM) and physical fitness performance (push up to failure, PU; 1-minute Sit Up, SU; and aerobic step test, PVO2max) were measured at wk-0, wk-4, wk-8, wk-12, and wk-16. This study found that LP does not have a significant effect on body composition, anthropometric and physical fitness performance of PCOS patients underwent a structured exercise program. It means LP does not improve exercise responses of PCOS patients towards anthropometric, body composition and physical fitness performance. The overall data shows exercise responses of PCOS patients is by increasing their aerobic endurance and muscle endurance performances, there is a significant reduction in FM, PBF, HC, and Wt significantly. Therefore, exercise program for PCOS patients have to focus on aerobic fitness, and muscle endurance.

Keywords: polycystic ovarian syndrome, Labisia pumila var. alata, body composition, aerobic endurance, muscle endurance, anthropometric

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1285 Nasopharyngeal Cancer in Children and Adolescents: Experience of Emir Abdelkader Cancer Center of Oran Algeria

Authors: Taleb L., Benarbia M., Brahmi M., Belmiloud H., Boukerche A.

Abstract:

Introduction and purpose of the study: Cavum cancer in children and adolescents is rare and represents 8% of all nasopharyngeal cancers treated in our department. Our objective is to study its epidemiological, clinical, therapeutic, and evolutionary particularities. Material and methods: Retrospective study of 39 patients under 20 years old, treated for undifferentiated non-metastatic carcinoma of the nasopharynx at the Emir Abdelkader Cancer Center between 2014 and 2020. Results and statistical analysis: Median age was 14 years [7-19 years], with a sex ratio of 2.9. The median time to diagnosis was 5.6 months [1 to 14 months], the circumstances of the discovery of which were dominated by lymph node syndrome in 43.6% of cases (n=17) followed by a rhinological syndrome in 30.8% of cases (n=13). The tumor stage was T1 for two patients (5.1%), T2 for 8 (20.5%), T3 for 9 (23.1%), T4 for 20 (51.3%), N0 for 2 (5 .1%) N1 for 4 (10.3%), N2 for 28 (71.8%) and N3 for 5 (12.8%). All patients received induction chemotherapy followed by concomitant radiotherapy with cisplatin. The dose of irradiation delivered to the cavum and adenopathies was 66 Gy with fractionation of 2 Gy per session in 69.2% of cases (n=27) and 1.8 Gy in 30.8% of cases (n=12). With a median follow-up of 51 months (15 to 97 months), the locoregional, metastatic, specific, and overall relapse-free survival rates at five years were 91.1%, 73.5%, 66.1%, and 68.4, respectively. Conclusion: Chemotherapy and radiotherapy treatment of cavum cancer in children and adolescents has allowed excellent locoregional control despite the advanced stage of the disease. However, the frequency of metastatic relapses could justify the possible use of systemic maintenance treatment.

Keywords: cancer, nasopharynx, radiotherapy, chemotherapy, survival

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1284 Failure Analysis of Laminated Veneer Bamboo Dowel Connections

Authors: Niloufar Khoshbakht, Peggi L. Clouston, Sanjay R. Arwade, Alexander C. Schreyer

Abstract:

Laminated veneer bamboo (LVB) is a structural engineered composite made from glued layers of bamboo. A relatively new building product, LVB is currently employed in similar sizes and applications as dimensional lumber. This study describes the results of a 3D elastic Finite Element model for halfhole specimens when loaded in compression parallel-to-grain per ASTM 5764. The model simulates LVB fracture initiation due to shear stresses in the dowel joint and predicts displacement at failure validated through comparison with experimental results. The material fails at 1mm displacement due to in-plane shear stresses. The paper clarifies the complex interactive state of in-plane shear, tension perpendicular-to-grain, and compression parallel-to-grain stresses that form different distributions in the critical zone beneath the bolt hole for half-hole specimens. These findings are instrumental in understanding key factors and fundamental failure mechanisms that occur in LVB dowel connections to help devise safe standards and further LVB product adoption and design.

Keywords: composite, dowel connection, embedment strength, failure behavior, finite element analysis, Moso bamboo

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1283 The Correlation between Head of Bed Angle and IntraAbdominal Pressure of Intubated Patients; a Pre-Post Clinical Trial

Authors: Sedigheh Samimian, Sadra Ashrafi, Tahereh Khaleghdoost Mohammadi, Mohammad Reza Yeganeh, Ali Ashraf, Hamideh Hakimi, Maryam Dehghani

Abstract:

Introduction: The recommended position for measuring Intra-Abdominal Pressure (IAP) is the supine position. However, patients put in this position are prone to Ventilator-associated pneumonia. This study was done to evaluate the relationship between bed head angle and IAP measurements of intubated patients in the intensive care unit. Methods: In this clinical trial, seventy-six critically ill patients under mechanical ventilation were enrolled. IAP measurement was performed every 8 hours for 24 hours using the KORN method in three different degrees of the head of bed (HOB) elevation (0°, 15°, and 30°). Bland-Altman analysis was performed to identify the bias and limits of agreement among the three HOBs. According to World Society of the Abdominal Compartment Syndrome (WSACS), we can consider two IAP techniques equivalent if a bias of <1 mmHg and limits of agreement of - 4 to +4 were found between them. Data were analyzed using SPSS statistical software (v. 19), and the significance level was considered as 0.05. Results: The prevalence of intra-abdominal hypertension was 18.42%. Mean ± standard deviation (SD) of IAP were 8.44 ± 4.02 mmHg for HOB angle 0°, 9.58 ± 4.52 for HOB angle 15°, and 11.10 ± 4.73 for HOB angle 30o (p = 0.0001). The IAP measurement bias between HOB angle 0◦ and HOB angle 15° was 1.13 mmHg. This bias was 2.66 mmHg between HOB angle 0° and HOB angle 30°. Conclusion: Elevation of HOB angle from 0 to 30 degree significantly increases IAP. It seems that the measurement of IAP at HOB angle 15° was more reliable than 30°.

Keywords: pressure, intra-abdominal hypertension, head of bed, critical care, compartment syndrome, supine position

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1282 Low-Dose Chest Computed Tomography Can Help in Differential Diagnosis of Asthma–COPD Overlap Syndrome in Children

Authors: Frantisek Kopriva, Kamila Michalkova, Radim Dudek, Jana Volejnikova

Abstract:

Rationale: Diagnostic criteria of asthma–COPD overlap syndrome (ACOS) are controversial in pediatrics. Emphysema is characteristic of COPD and usually does not occur in typical asthma; its presence in patients with asthma suggests the concurrence with COPD. Low-dose chest computed tomography (CT) allows a non-invasive assessment of the lung tissue structure. Here we present CT findings of emphysematous changes in a child with ACOS. Patient and Methods: In a 6-year-old boy, atopy was confirmed by a skin prick test using common allergen extracts (grass and tree pollen, house dust mite, molds, cat, dog; manufacturer Stallergenes Greer, London, UK), where reactions over 3 mm were considered positive. Treatment with corticosteroids was started during the course of severe asthma. At 12 years of age, his spirometric parameters deteriorated despite treatment adjustment (VC 1.76 L=85%, FEV1 1.13 L=67%, TI%VCmax 64%, MEF25 19%, TLC 144%) and the bronchodilator test became negative. Results: Low-dose chest CT displayed irregular regions with increased radiolucency of pulmonary parenchyma (typical for hyperinflation in emphysematous changes) in both lungs. This was in accordance with the results of spirometric examination. Conclusions: ACOS is infrequent in children. However, low-dose chest CT scan can be considered to confirm this diagnosis or eliminate other diagnoses when the clinical condition is deteriorating and treatment response is poor.

Keywords: child, asthma, low-dose chest CT, ACOS

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1281 Investigating the Role of Social Media in Supporting Parents and Teachers of Students with Down Syndrome: Focus on Early Intervention Services in the Kingdom of Saudi Arabia

Authors: Awatif Habeeb Al-Shamare

Abstract:

The number of social media users amongst special education teachers and parents of children with Down Syndrome (DS) is increasing annually. This is also the case in the Kingdom of Saudi Arabia (KSA). However, according to the best of the author’s knowledge, there are no qualitative studies which testify to the true nature of the interaction between teachers and parents when using social media, nor the role of social media in supporting and assisting parents and teachers with regards to the children’s educational needs in KSA. Therefore, this ongoing study aims to identify the role of social media in supporting parents and teachers of DS students, with a special emphasis on early intervention services in KSA. By bridging the knowledge gap on social media and special education in KSA and presenting socially relevant and applied information on the topic, this research provides a theoretical and practical base for the establishment of appropriate and effective programmes between the ministries of Information and Special Education in particular. A qualitative approach was selected because it was the most suitable approach for exploring the participants’ experiences, which could not be determined through scientific tests. Interviewing, chosen as the research instrument, allowed the researcher to obtain a detailed understanding of the topic linked to the study objectives. Initially, a pilot study was conducted at the Daycare Center in May 2016. Its aim was to examine and refine the methodology and assess whether the questions were understood with the potential for re-drafting them, if necessary. The main study consists of five teachers and five mothers with experience of using social media and with links to the Daycare Center. Thematic Analysis has been chosen for analysing the findings because it is a flexible method that allows themes to emerge from the data. Results of the current study are still in the initial stages, but the preliminary findings are as follows: (1) social media is an important tool in encouraging parents and teachers to access the necessary information and knowledge about, and experience in, early intervention services; (2) it acts as a support network for the parents; (3) it helps raise awareness about DS and the need for early intervention; (4) it can be used to put pressure on the government for an expansion in early intervention services, and finally (5) its use can be problematic in that parents and teachers face some difficulties and challenges when using the different platforms. It can be concluded that social media plays a significant role in the lives of teachers and parents with special needs children in KSA.

Keywords: down syndrome, early intervention services, social media, support parents and teachers

Procedia PDF Downloads 146
1280 Effect of Mineral Additives on Improving the Geotechnical Properties of Soils in Chlef

Authors: Messaoudi Mohammed Amin

Abstract:

The reduction of available land resources and the increased cout associated with the use of hight quality materials have led to the need for local soils to be used in geotecgnical construction however, poor engineering properties of these soils pose difficulties for constructions project and need to be stabilized to improve their properties in oyher works unsuitable soils with low bearing capacity, high plasticity coupled with high insatbility are frequently encountered hense, there is a need to improve the physical and mechanical charateristics of these soils to make theme more suitable for construction this can be done by using different mechanical and chemical methods clayey soil stabilization has been practiced for quite sometime bu mixing additives, such us cement, lime and fly ash to the soil to increase its strength. The aim of this project is to study the effect of using lime, natural pozzolana or combination of both on the geotecgnical cherateristics of clayey soil. Test specimen were subjected to atterberg limits test, compaction test, box shear test and uncomfined compression test Lime or natural pozzolana was added to clayey soil at rangs of 0-8% and 0-20% respectively. In addition combinations of lime –natural pozzolana were added to clayey soil at the same ranges specimen were cured for 1-7, and 28 days after which they were tested for uncofined compression tests. Based on the experimental results, it was concluded that an important decrease of plasticity index was observed for thr samples stabilized with the combinition lime-natural pozzolana in addition, the use of the combination lime-natural pozzolana modifies the clayey soil classification according to casagrand plasiticity chart. Moreover, based on the favourable results of shear and compression strength obtained, it can be concluded that clayey soil can be successfuly stabilized by combined action of lime and natural pozzolana also this combination showed an appreciable improvement of the shear parameters. Finally, since natural pozzolana is much cheaper than lime ,the addition of natural pozzolana in lime soil mix may particulary become attractive and can result in cost reduction of construction.

Keywords: clay, soil stabilization, natural pozzolana, atterberg limits, compaction, compressive strength shear strength, curing

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1279 A Difficult Advertising: A Preventive Intervention for Siblings of Children with down Syndrome

Authors: Valentina Manna, Oscar Pisanti

Abstract:

The term sibling has been adopted by Italian brothers and sisters of people with disabilities, to define themselves as a group with shared features. This choice is due to the importance of underlying the centrality of what being a brother/sister means to these people because of and beyond the disability. Being a sibling offers great opportunities to develop empathy and relational skills but it may also amplify the typical dynamics of fraternal relationships dealing with envy, rivalry and concern. This outlines a condition of potential developmental risk for the non-disabled sibling, being at the same time a great resource for the child with special needs, as actor of an intimate relationship usually lasting after that one with parents. However, young siblings are often unheeded in their needs for comprehension of disability and not considered as persons requiring attention themselves. Moreover, scholars have scarcely undertaken an exploration of siblings’ perspective as competent contributors for producing knowledge useful to the benefit of families with special needs children. This contribution describes a preventive intervention for young siblings (6 – 16 years) of children with Down syndrome, by means of a psychodynamic-oriented group where participants could communicate, explore and share their emotional experiences as siblings. Based on a participatory approach, the program represents an action-research project, involving siblings as key experts for our understanding of siblings’ lives. The initiative used social media and video technologies to rise children’s voice: as a final product, participants were involved in the realization of a video campaign –which they defined ‘a difficult advertising’– built on the insights generated by the program and addressed to other siblings to help them facing and recognizing resources and difficulties related to their status. The final video campaign realized by the participants summarizes the main themes emerged during the intervention; as revealed by a thematic analysis, they are related to the difficulty in feeling to have a personal identity, to face disability as a form of ‘untought known’ and to integrate ambivalent emotions. In conclusion, the group device revealed its efficacy as a preventive tool: it allowed participants to deeply reflect on their own experiences and to communicate them for the first time in a verbal and mentalized form.

Keywords: down syndrome, group, siblings, prevention

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1278 Optimizing Foaming Agents by Air Compression to Unload a Liquid Loaded Gas Well

Authors: Mhenga Agneta, Li Zhaomin, Zhang Chao

Abstract:

When velocity is high enough, gas can entrain fluid and carry to the surface, but as time passes by, velocity drops to a critical point where fluids will start to hold up in the tubing and cause liquid loading which prevents gas production and may lead to the death of the well. Foam injection is widely used as one of the methods to unload liquid. Since wells have different characteristics, it is not guaranteed that foam can be applied in all of them and bring successful results. This research presents a technology to optimize the efficiency of foam to unload liquid by air compression. Two methods are used to explain optimization; (i) mathematical formulas are used to solve and explain the myth of how density and critical velocity could be minimized when air is compressed into foaming agents, then the relationship between flow rates and pressure increase which would boost up the bottom hole pressure and increase the velocity to lift liquid to the surface. (ii) Experiments to test foam carryover capacity and stability as a function of time and surfactant concentration whereby three surfactants anionic sodium dodecyl sulfate (SDS), nonionic Triton 100 and cationic hexadecyltrimethylammonium bromide (HDTAB) were probed. The best foaming agents were injected to lift liquid loaded in a created vertical well model of 2.5 cm diameter and 390 cm high steel tubing covered by a transparent glass casing of 5 cm diameter and 450 cm high. The results show that, after injecting foaming agents, liquid unloading was successful by 75%; however, the efficiency of foaming agents to unload liquid increased by 10% with an addition of compressed air at a ratio of 1:1. Measured values and calculated values were compared and brought about ± 3% difference which is a good number. The successful application of the technology indicates that engineers and stakeholders could bring water flooded gas wells back to production with optimized results by firstly paying attention to the type of surfactants (foaming agents) used, concentration of surfactants, flow rates of the injected surfactants then compressing air to the foaming agents at a proper ratio.

Keywords: air compression, foaming agents, gas well, liquid loading

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1277 Review of Consecutive Patients Treated with a Combination of Vancomycin and Rifaximin for Diarrhea Predominant Irritable Bowel Syndrome (IBS-D)

Authors: Portia Murphy, Danica Vasic, Anoja W. Gunaratne, Encarnita Sitchon, Teresita Tugonon, Marou Ison, Antoinette Le Busque, Christelle Pagonis, Thomas J. Borody

Abstract:

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that affects an estimated 11% of the population globally with the most predominant symptoms being abdominal pain, bloating and altered bowel movements. All age groups suffer from IBS although the prevalence of IBS decreases for age groups over 50 years. Women are more likely to suffer from IBS than men. IBS can be categorized into 3 groups based on the type of altered bowel movement: diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C) and IBS with mixed bowel habit (IBS-M). The contribution of the gut microbiome to the etiology of IBS is becoming increasingly recognized with rising use of anti-microbial agents. Previous studies on vancomycin and rifaximin used as monotherapy or in combination have been conducted mainly on IBS-C and showed marked improvements in the symptoms. According to our knowledge, no studies reported using these two combinations of antibiotics for IBS-D. Here, we report a consecutive cohort of 18 patients treated with both vancomycin and rifaximin for IBS-D. These patients’ records were reviewed retrospectively. In this cohort, patients ages were between 24-74 years (mean 44 years) and 9 were female. Baseline all patients had diarrhea, 4 with mucus and one with blood. Patients reported other symptoms were abdominal pain (n=11) bloating (n=9), flatulence (n=7), fatigue (n=4) and nausea (n=3). Patients treatments were personalized according to their symptom severity and tolerability and were treated with combination of rifaximin (500 - 3000mg/d) and vancomycin (500mg - 1500mg/d) for an ongoing period. Follow-ups were conducted between 2-32 weeks’ time. Of all patients, 89% patients reported improvement of the symptoms, 1 reported no change and 1 patient’s symptoms got worse. The mechanism of action for both vancomycin and rifaximin involves the inhibition of bacterial cell wall and protein synthesis respectively. The role of these medications in improving the symptoms of this cohort suggests that IBS-D may be microbiome infection driven. In this cohort, similar patient presentations to Clostridium difficile, as well as symptom improvement with the use of rifaximin and particularly vancomycin, suggest that the infectious agent may be an unidentified Clostridium. These preliminary results offer an alternative etiology for IBS-D not previously considered and open the avenue for new research.

Keywords: clostridium deficile, diarrhea predominant Irritable Bowel Syndrome, microbiome, vancomycin/rifaximin combination

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